Data Specialist I - Nursing Administration

CHRISTUS Health•Alexandria, LA

About The Position

The Data Specialist I identifies system issues and provides defect-resolution analysis through claims and system analysis in support of the Benefits Configuration and Provider Data departments. The role researches data quality issues, analyzes benefit coverage and provider data in the claims payment system, and investigates root causes that may affect claims payments or denials. It also supports claims payment analysis, communicates findings and recommendations, and contributes to improvements in system accuracy, departmental workflows, and compliance.

Requirements

Associate Degree

Responsibilities

Assist with database improvements and audits.
Research and communicate data quality issues by comparing system information with applicable claims, benefit structures, contract details, and pricing methodologies.
Analyze benefit coverage and provider data in the claims payment system to identify root causes of data quality issues affecting claims payments or denials.
Initiate claims payment analysis in response to internal Health Plan requests, partnering with the BI department to obtain reports that help determine provider underpayments and overpayments.
Catalog internal defect results and recommendations, and communicate findings to affected departments and appropriate leadership.
Collaborate and maintain open communication with departments across CHRISTUS Health to support efficient workflows and completion of tasks and goals.
Assist with developing and maintaining departmental goals and objectives, and maintain personal goals on a quarterly basis.
Assist in developing action plans to address system deficiencies and ensure claims adjudicate correctly.
Monitor and track best practices, and review compliance changes and impacts to identify continuous-improvement opportunities.
Identify prevalent trends through data reporting and claims analysis.
Assist in circulating information to staff as needed.
Perform other related duties and special projects as requested.
Follow CHRISTUS Guidelines related to HIPAA to prevent or detect unauthorized disclosure of Protected Health Information (PHI).